Influence of the left atrial contact areas on fixed low‐voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation
Background Atrial low‐voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear. Objective To assess whether CoA regions were involved in atrial substrate prop...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2017-11, Vol.28 (11), p.1259-1268 |
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| container_title | Journal of cardiovascular electrophysiology |
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| creator | Nakahara, Shiro Hori, Yuichi Nishiyama, Naoki Okumura, Yasuo Fukuda, Reiko Kobayashi, Sayuki Komatsu, Takaaki Sakai, Yoshihiko Taguchi, Isao |
| description | Background
Atrial low‐voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear.
Objective
To assess whether CoA regions were involved in atrial substrate properties maintaining PsAF.
Methods
A total of 50 patients with PsAF (36 long‐lasting) were analyzed. Three representative CoA detection areas (ascending aorta‐anterior‐LA, descending aorta‐left pulmonary vein antrum, and vertebrae‐posterior‐LA) were registered on the mapping geometry. Electrograms during AF and sinus rhythm (SR) were acquired, and the fractionated electrograms (CFE; 5% of the total LA surface area). Patients with long‐lasting PsAF versus PsAF had larger CoA areas (7.7 ± 3.0 vs. 4.5 ± 2.5cm2, P |
| doi_str_mv | 10.1111/jce.13301 |
| format | Article |
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Atrial low‐voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear.
Objective
To assess whether CoA regions were involved in atrial substrate properties maintaining PsAF.
Methods
A total of 50 patients with PsAF (36 long‐lasting) were analyzed. Three representative CoA detection areas (ascending aorta‐anterior‐LA, descending aorta‐left pulmonary vein antrum, and vertebrae‐posterior‐LA) were registered on the mapping geometry. Electrograms during AF and sinus rhythm (SR) were acquired, and the fractionated electrograms (CFE; < 80milliseconds) and voltages were analyzed regarding the CoAs.
Results
After SR conversion, 76% (38/50) had a significant LVZ (>5% of the total LA surface area). Patients with long‐lasting PsAF versus PsAF had larger CoA areas (7.7 ± 3.0 vs. 4.5 ± 2.5cm2, P < 0.05) and overlapped‐LVZs (8.2 [3.2–11.0] vs. 2.1 [0.7–3.7] cm2, P = 0.0126) between the SR‐LVZs (<0.5 mV) and AF‐LVZs (<0.2 mV). Overlapped‐LVZs were frequently observed in CoA regions (anterior 76.4%; LIPV antrum 78.8%, and vertebrae 39.2%), and those LVZs had smaller unipolar voltages than those distant from the CoA regions (0.64 ± 0.16 vs. 2.5 ± 1.5 mV, P < 0.0001). SR‐LVZ targeted ablation, including of CoA regions, rendered AF termination (n = 8, 21%), and 88% of the sites were not located immediately above, but adjacent to, the overlapped‐LVZs. Significant AF slowing (6.0 ± 0.6 to 5.6 ± 0.6 Hz; P < 0.05) accompanied by unintentional CFE elimination (9.8–1.8 cm2; P < .0001) was achieved in patients without termination.
Conclusion
Our data suggested that external structures in contact with the LA are involved in the creation of localized diseased myocardium necessary for PsAF maintenance.]]></description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.13301</identifier><identifier>PMID: 28727202</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aorta ; atrial fibrillation ; Atrial Fibrillation - diagnostic imaging ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Cardiac arrhythmia ; catheter ablation ; Catheter Ablation - methods ; Cohort Studies ; Coronary vessels ; Electrophysiologic Techniques, Cardiac - methods ; Female ; Fibrillation ; Heart Atria - diagnostic imaging ; Heart Atria - surgery ; Heart Rate - physiology ; Humans ; low‐voltage region ; Male ; Middle Aged ; Myocardium ; Pulmonary Veins - diagnostic imaging ; Pulmonary Veins - surgery ; Retrospective Studies ; Sinoatrial Node - physiology ; Sinus ; Spine ; Vertebrae ; Voltage</subject><ispartof>Journal of cardiovascular electrophysiology, 2017-11, Vol.28 (11), p.1259-1268</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>Journal compilation © 2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-5052e6137e877c12e9998280bf06025e3a4aac2122b04378d72d5add55a042a33</citedby><cites>FETCH-LOGICAL-c3531-5052e6137e877c12e9998280bf06025e3a4aac2122b04378d72d5add55a042a33</cites><orcidid>0000-0002-6388-4398</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.13301$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.13301$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28727202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakahara, Shiro</creatorcontrib><creatorcontrib>Hori, Yuichi</creatorcontrib><creatorcontrib>Nishiyama, Naoki</creatorcontrib><creatorcontrib>Okumura, Yasuo</creatorcontrib><creatorcontrib>Fukuda, Reiko</creatorcontrib><creatorcontrib>Kobayashi, Sayuki</creatorcontrib><creatorcontrib>Komatsu, Takaaki</creatorcontrib><creatorcontrib>Sakai, Yoshihiko</creatorcontrib><creatorcontrib>Taguchi, Isao</creatorcontrib><title>Influence of the left atrial contact areas on fixed low‐voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description><![CDATA[Background
Atrial low‐voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear.
Objective
To assess whether CoA regions were involved in atrial substrate properties maintaining PsAF.
Methods
A total of 50 patients with PsAF (36 long‐lasting) were analyzed. Three representative CoA detection areas (ascending aorta‐anterior‐LA, descending aorta‐left pulmonary vein antrum, and vertebrae‐posterior‐LA) were registered on the mapping geometry. Electrograms during AF and sinus rhythm (SR) were acquired, and the fractionated electrograms (CFE; < 80milliseconds) and voltages were analyzed regarding the CoAs.
Results
After SR conversion, 76% (38/50) had a significant LVZ (>5% of the total LA surface area). Patients with long‐lasting PsAF versus PsAF had larger CoA areas (7.7 ± 3.0 vs. 4.5 ± 2.5cm2, P < 0.05) and overlapped‐LVZs (8.2 [3.2–11.0] vs. 2.1 [0.7–3.7] cm2, P = 0.0126) between the SR‐LVZs (<0.5 mV) and AF‐LVZs (<0.2 mV). Overlapped‐LVZs were frequently observed in CoA regions (anterior 76.4%; LIPV antrum 78.8%, and vertebrae 39.2%), and those LVZs had smaller unipolar voltages than those distant from the CoA regions (0.64 ± 0.16 vs. 2.5 ± 1.5 mV, P < 0.0001). SR‐LVZ targeted ablation, including of CoA regions, rendered AF termination (n = 8, 21%), and 88% of the sites were not located immediately above, but adjacent to, the overlapped‐LVZs. Significant AF slowing (6.0 ± 0.6 to 5.6 ± 0.6 Hz; P < 0.05) accompanied by unintentional CFE elimination (9.8–1.8 cm2; P < .0001) was achieved in patients without termination.
Conclusion
Our data suggested that external structures in contact with the LA are involved in the creation of localized diseased myocardium necessary for PsAF maintenance.]]></description><subject>Aged</subject><subject>Aorta</subject><subject>atrial fibrillation</subject><subject>Atrial Fibrillation - diagnostic imaging</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Cardiac arrhythmia</subject><subject>catheter ablation</subject><subject>Catheter Ablation - methods</subject><subject>Cohort Studies</subject><subject>Coronary vessels</subject><subject>Electrophysiologic Techniques, Cardiac - methods</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart Atria - diagnostic imaging</subject><subject>Heart Atria - surgery</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>low‐voltage region</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardium</subject><subject>Pulmonary Veins - diagnostic imaging</subject><subject>Pulmonary Veins - surgery</subject><subject>Retrospective Studies</subject><subject>Sinoatrial Node - physiology</subject><subject>Sinus</subject><subject>Spine</subject><subject>Vertebrae</subject><subject>Voltage</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1OHDEQha0IFH6SRS6ALLEJiwb_truXaASECIlNsm553NWMRx57sN1MhhVHYMMFc5I4GWCBSG2qSvreU6keQl8oOaalTuYGjinnhH5Au1QKUjW0VltlJkJWvFF8B-2lNCeE8prIj2iHNYopRtguerr0gxvBG8BhwHkG2MGQsc7RaodN8FmbskbQCQePB_sLeuzC6vfD411wWd8Avg8eEu7HaP3Ni3Cw02id09kWkfY9TtaPCcfZOs8W2Hq8hJhsyuDze5JPaHvQLsHn576Pfp6f_Zh8q66uLy4np1eV4ZLTShLJoKZcQaOUoQzatm1YQ6YDqQmTwLXQ2jDK2JQIrppesV7qvpdSE8E05_vo68Z3GcPtCCl3C5sMlCs8hDF1tGWUckGEKOjhG3QexujLdYWqeXm4aNtCHW0oE0NKEYZuGe1Cx3VHSfc3q65k1f3LqrAHz47jdAH9K_kSTgFONsDKOlj_36n7PjnbWP4BMUifrw</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Nakahara, Shiro</creator><creator>Hori, Yuichi</creator><creator>Nishiyama, Naoki</creator><creator>Okumura, Yasuo</creator><creator>Fukuda, Reiko</creator><creator>Kobayashi, Sayuki</creator><creator>Komatsu, Takaaki</creator><creator>Sakai, Yoshihiko</creator><creator>Taguchi, Isao</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6388-4398</orcidid></search><sort><creationdate>201711</creationdate><title>Influence of the left atrial contact areas on fixed low‐voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation</title><author>Nakahara, Shiro ; Hori, Yuichi ; Nishiyama, Naoki ; Okumura, Yasuo ; Fukuda, Reiko ; Kobayashi, Sayuki ; Komatsu, Takaaki ; Sakai, Yoshihiko ; Taguchi, Isao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-5052e6137e877c12e9998280bf06025e3a4aac2122b04378d72d5add55a042a33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Aorta</topic><topic>atrial fibrillation</topic><topic>Atrial Fibrillation - diagnostic imaging</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Cardiac arrhythmia</topic><topic>catheter ablation</topic><topic>Catheter Ablation - methods</topic><topic>Cohort Studies</topic><topic>Coronary vessels</topic><topic>Electrophysiologic Techniques, Cardiac - methods</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart Atria - diagnostic imaging</topic><topic>Heart Atria - surgery</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>low‐voltage region</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardium</topic><topic>Pulmonary Veins - diagnostic imaging</topic><topic>Pulmonary Veins - surgery</topic><topic>Retrospective Studies</topic><topic>Sinoatrial Node - physiology</topic><topic>Sinus</topic><topic>Spine</topic><topic>Vertebrae</topic><topic>Voltage</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakahara, Shiro</creatorcontrib><creatorcontrib>Hori, Yuichi</creatorcontrib><creatorcontrib>Nishiyama, Naoki</creatorcontrib><creatorcontrib>Okumura, Yasuo</creatorcontrib><creatorcontrib>Fukuda, Reiko</creatorcontrib><creatorcontrib>Kobayashi, Sayuki</creatorcontrib><creatorcontrib>Komatsu, Takaaki</creatorcontrib><creatorcontrib>Sakai, Yoshihiko</creatorcontrib><creatorcontrib>Taguchi, Isao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakahara, Shiro</au><au>Hori, Yuichi</au><au>Nishiyama, Naoki</au><au>Okumura, Yasuo</au><au>Fukuda, Reiko</au><au>Kobayashi, Sayuki</au><au>Komatsu, Takaaki</au><au>Sakai, Yoshihiko</au><au>Taguchi, Isao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of the left atrial contact areas on fixed low‐voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2017-11</date><risdate>2017</risdate><volume>28</volume><issue>11</issue><spage>1259</spage><epage>1268</epage><pages>1259-1268</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract><![CDATA[Background
Atrial low‐voltage zones (LVZ) are suggested as important factors for maintaining persistent atrial fibrillation (PsAF). The relationship between LVZs and left atrial (LA) contact areas (CoAs) is still unclear.
Objective
To assess whether CoA regions were involved in atrial substrate properties maintaining PsAF.
Methods
A total of 50 patients with PsAF (36 long‐lasting) were analyzed. Three representative CoA detection areas (ascending aorta‐anterior‐LA, descending aorta‐left pulmonary vein antrum, and vertebrae‐posterior‐LA) were registered on the mapping geometry. Electrograms during AF and sinus rhythm (SR) were acquired, and the fractionated electrograms (CFE; < 80milliseconds) and voltages were analyzed regarding the CoAs.
Results
After SR conversion, 76% (38/50) had a significant LVZ (>5% of the total LA surface area). Patients with long‐lasting PsAF versus PsAF had larger CoA areas (7.7 ± 3.0 vs. 4.5 ± 2.5cm2, P < 0.05) and overlapped‐LVZs (8.2 [3.2–11.0] vs. 2.1 [0.7–3.7] cm2, P = 0.0126) between the SR‐LVZs (<0.5 mV) and AF‐LVZs (<0.2 mV). Overlapped‐LVZs were frequently observed in CoA regions (anterior 76.4%; LIPV antrum 78.8%, and vertebrae 39.2%), and those LVZs had smaller unipolar voltages than those distant from the CoA regions (0.64 ± 0.16 vs. 2.5 ± 1.5 mV, P < 0.0001). SR‐LVZ targeted ablation, including of CoA regions, rendered AF termination (n = 8, 21%), and 88% of the sites were not located immediately above, but adjacent to, the overlapped‐LVZs. Significant AF slowing (6.0 ± 0.6 to 5.6 ± 0.6 Hz; P < 0.05) accompanied by unintentional CFE elimination (9.8–1.8 cm2; P < .0001) was achieved in patients without termination.
Conclusion
Our data suggested that external structures in contact with the LA are involved in the creation of localized diseased myocardium necessary for PsAF maintenance.]]></abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28727202</pmid><doi>10.1111/jce.13301</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-6388-4398</orcidid></addata></record> |
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| subjects | Aged Aorta atrial fibrillation Atrial Fibrillation - diagnostic imaging Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Cardiac arrhythmia catheter ablation Catheter Ablation - methods Cohort Studies Coronary vessels Electrophysiologic Techniques, Cardiac - methods Female Fibrillation Heart Atria - diagnostic imaging Heart Atria - surgery Heart Rate - physiology Humans low‐voltage region Male Middle Aged Myocardium Pulmonary Veins - diagnostic imaging Pulmonary Veins - surgery Retrospective Studies Sinoatrial Node - physiology Sinus Spine Vertebrae Voltage |
| title | Influence of the left atrial contact areas on fixed low‐voltage zones during atrial fibrillation and sinus rhythm in persistent atrial fibrillation |
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